Métatarsalgies - Orientation diagnostique

<table id="refer1" cellpadding="5"><caption>Tableau 1 - M&eacute;tatarsalgies</caption><tbody><tr><th colspan="2">Approche diagnostique</th></tr><tr><td style="text-align: center;"><strong>Clinique</strong></td><td><ul><li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Examen de la marche.</span></li><li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Examen des chaussures.</span></li><li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Recherche d&rsquo;un trouble de la statique du pied (pied &eacute;quin, pied creux).</span></li><li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Recherche de zones d'hyper-appuis (hyperk&eacute;ratose, cor, &oelig;il de perdrix).</span></li></ul></td></tr><tr><td style="text-align: center;"><strong>Imagerie</strong></td><td><ul><li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Radiographies des pieds : face et profil en charge (</span><span style="font-weight: 400;"><a href="/ordonnances-types/metatarsalgies---radiographies" target="_blank" rel="noopener">ordonnance</a></span><span style="font-weight: 400;">).</span></li><li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">&Eacute;chographie, id&eacute;alement avec une sonde club de golf (</span><a href="/ordonnances-types/metatarsalgies---echographie" target="_blank" rel="noopener"><span style="font-weight: 400;">ordonnance</span></a><span style="font-weight: 400;">).</span></li><li style="font-weight: 400;" aria-level="1">IRM en cas de doute diagnostique (<a href="/ordonnances-types/metatarsalgies---irm" target="_blank" rel="noopener">ordonnance</a>).</li></ul></td></tr><tr><th colspan="2">&Eacute;tiologies</th></tr><tr><td style="text-align: center;"><strong>Biom&eacute;caniques</strong></td><td><span style="font-weight: 400;">M&eacute;tatarsalgies statiques et syndrome du 2</span>^{<span style="font-weight: 400;">e</span>}<span style="font-weight: 400;"> rayon : </span><span style="font-weight: 400;">voir <a href="/pathologies/metatarsalgies-statiques-et-syndrome-du-2e-rayon" target="_blank" rel="noopener">fiche</a></span></td></tr><tr><td style="text-align: center;"><strong>Pathologies intercapito-m&eacute;tatarsienne</strong></td><td><span style="font-weight: 400;">(Pseudo)-n&eacute;vrome de Morton et bursite intercapito-m&eacute;tatarsienne : </span><span style="font-weight: 400;">voir <a href="/pathologies/nevrome-de-morton-et-bursite-intercapito-metatarsienne" target="_blank" rel="noopener">fiche</a></span></td></tr><tr><td style="text-align: center;"><strong>Pathologies osseuses</strong></td><td><span style="font-weight: 400;">Fracture de contrainte, ost&eacute;ochondrite et n&eacute;crose avasculaire (Freiberg) : </span><span style="font-weight: 400;">voir </span><a href="/pathologies/fracture-de-contrainte-metatarsienne-necrose-avasculaire-de-tete-metatarsienne-freiberg" target="_blank" rel="noopener"><span style="font-weight: 400;">fiche</span></a></td></tr><tr><td style="text-align: center;"><strong>Atteinte du 1^er et 5^e rayon</strong></td><td><span style="font-weight: 400;">Voir <a href="/pathologies/hallux-rigidus-sesamoidite-et-metatarsalgie-du-5e-rayon" target="_blank" rel="noopener">fiche</a></span></td></tr><tr><td style="text-align: center;"><strong>Autres causes</strong></td><td><ul><li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Pathologies ost&eacute;oarticulaires inflammatoires (synovite m&eacute;tatarso-phalangienne, bursite sous-capitale ou intercapito-m&eacute;tatarsienne) :</span></li><ul><li style="font-weight: 400;" aria-level="2"><span style="font-weight: 400;">SpA</span><span style="font-weight: 400;">/Rhumatisme psoriasique, dont dactylite et onycho-pachydermo-p&eacute;riostite (voir </span><a href="/pathologies/rhumatisme-psoriasique-rhumatologie" target="_blank" rel="noopener"><span style="font-weight: 400;">fiche</span></a><span style="font-weight: 400;">),</span></li><li style="font-weight: 400;" aria-level="2"><span style="font-weight: 400;">PR (voir </span><a href="/pathologies/polyarthrite-rhumatoide" target="_blank" rel="noopener"><span style="font-weight: 400;">fiche</span></a><span style="font-weight: 400;">) active, ou complication de PR ancienne destructrice avec pied triangulaire et saillie des t&ecirc;tes m&eacute;tatarsiennes &agrave; travers un capiton atrophi&eacute;,</span></li><li style="font-weight: 400;" aria-level="2"><span style="font-weight: 400;">goutte : MTP1 notamment (voir </span><a href="/pathologies/goutte-rhumatologie" target="_blank" rel="noopener"><span style="font-weight: 400;">fiche</span></a><span style="font-weight: 400;">),</span></li><li style="font-weight: 400;" aria-level="2"><span style="font-weight: 400;">rhumatisme apatitique de l&rsquo;avant-pied,</span></li><li style="font-weight: 400;" aria-level="2"><span style="font-weight: 400;">ost&eacute;ite chronique non bact&eacute;rienne (ex-SAPHO) (ost&eacute;ite).</span></li></ul><li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Infection.</span></li><li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Traumatisme.</span></li><li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Pathologie ost&eacute;oarticulaire m&eacute;canique (arthrose).</span></li><li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Pathologie cutan&eacute;e.</span></li><li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Pathologie osseuse rare (tumorale, maladie de Paget).</span></li><li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Pied diab&eacute;tique (voir </span><a href="/pathologies/soins-pied-diabetique" target="_blank" rel="noopener"><span style="font-weight: 400;">fiche</span></a><span style="font-weight: 400;">).</span></li><li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">SDRC (voir </span><a href="/pathologies/sdrc-rhumatologie" target="_blank" rel="noopener"><span style="font-weight: 400;">fiche</span></a><span style="font-weight: 400;">).</span></li><li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Pathologie vasculaire.</span></li><li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Pathologie neurologique (dont syndrome canalaire).</span></li></ul></td></tr></tbody></table>